Comparing paclitaxel-platinum with ifosfamide-platinum as the front-line chemotherapy for patients with advanced-stage uterine carcinosarcoma

Abstract

Malignant mixed Müllerian tumors (MMMT, carcinosarcomas [CS]) of female genital tract are defined histologically as a biphasic tumor consisting of both carcinoma (malignant epithelial elements) and sarcoma (malignant mesenchymal or stromal elements) components. 1-3 CS usually arises from the uterus but may also rarely appear in the ovary, Fallopian tube, cervix, or peritoneum. [4][5][6] In the past and traditionally, uterine CS (UCS) has been regarded as a subtype of uterine sarcomas and is often analyzed after grouping other uterine sarcomas, such as undifferentiated uterine sarcoma, endometrial stromal sarcoma, and leiomyosarcoma. [7][8][9][10] Recently, clinical, pathologic, and biological evidence has indicated that UCS is a monoclonal origin, which is derived from the Müllerian duct and closely related to high-grade endometrial carcinoma with the driving force to result in sarcomatous transformation (metaplastic carcinoma), and subsequently form the homologous or heterologous groups, depending on the characteristics of the stroma or mesenchymal components of endometrial tissues. [11][12][13] Primary complete surgical staging or primary cytoreductive surgery (PCS) is a key factor in the management of women with UCS, based on the studies obtained from the experience for high-grade or advanced endometrial cancer and uterine sarcomas as well as epithelial ovarian cancer, primary peritoneal serous carcinoma, and primary fallopian tube cancers. 10,14-21 PCS includes a total hysterectomy, bilateral salpingo-oophorectomy,

Abandon ifosfamide-based regimen and use paclitaxel-carboplatin regimen for the treatment of uterine carcinosarcoma

“…4 The results showed a longer median PFS in the paclitaxel-platinum regimen group than that in the ifosfamide-platinum regimen group (23.1 months versus 4.9 months, p = 0.04). 4 Although the statistical analysis about measuring OS failed to reach the significance, patients treated with paclitaxel-platinum regimen still showed a trend of the longer median OS than ifosfamide-platinum regimen did (28.7 months versus 9.5 months, p = 0.06). 4 Because only 16 patients were enrolled in our study, we cannot make a strong conclusion to recommend that using paclitaxel-platinum regimen for the treatment of advanced UCS patients may be a better choice.…”

Neoadjuvant therapy

“…12,13 The basic concept should be well informed that the theoretical background of combination of CT and RT is significantly different from CCRT, and the former is given for both systemic and localized therapy, but the latter is limited to localized disease (any CT given to patients based on enhanced therapeutic effect of RT). 12,13 Similar to the principle of statistics applied to the clinical data presentation, 14,15 the theoretical principle is often miss-used in the routine clinical practice. For clinical practice, combination of CT and RT is often associated with more therapy-related AEs, even though both combinations of CT and RT and CCRT will additionally augment the therapy-related toxicity, compared to RT alone.…”

Molecular pathology-integrated clinicopathological prognostic factors

“…[1][2][3] Cancer treatment can be simply grouped into two distinguished therapeutic approaches; one is the highly curative therapy applied either by surgery alone and/or radiation therapy with/without neoadjuvant therapy (NAT) or adjuvant therapy under multi-modality guidance; and the other is the palliative therapy or multidisciplinary decision-making with low possibility of curability, based on the characteristics and patterns of diseases at the initial diagnosis. [4][5][6][7][8][9] Except of some specific systemic diseases, patients with an in situ or organ-limited diseases have a better chance to be cured accompanied with a long-term survival after the initial primary curative treatment. 2 However, few patients with proposed curable diseases may recur later even though the initial primary active and curative treatment is given, and subsequently die of diseases, suggesting that an accurate and precise evaluation and appropriate and personalized therapeutic plan to those patients with supposedly curable diseases by far-advanced development of new technology or therapeutic strategy is critically important.…”

“…In fact, stage is the most important and independent prognostic factor for nearly all solid tumors. 2,8 In theory, it is hard to identify any biomarker showing the similar value as stage in the prediction of outcome of the solid tumors. Therefore, it is not surprising to find little assistance of these biomarkers in the prediction of outcomes (DFS, PFS, or OS) of GC patients.…”